Dr Justine Davies will discuss the importance of data and measuring surgical metrics at the SAFE-T Summit on 13th April at the RSM, London. As these are topics the WFSA is passionate about, we wanted to learn more about her career, including her work on The Lancet Commission for Global Surgery, her current work, and why data matters.

WFSA: You were involved in the process of setting up The Lancet Commission for Global Surgery which really elevated surgery and anaesthesia in the global health sphere. Can you tell us about how that came about and why you were inspired to take action?

Justine Davies: At the time of the first Global Surgical Frontiers’ conference in London I was working at The Lancet journal as an executive editor and was invited to attend. It was great to see people being pulled together around a theme where there is so much need, so I wrote an editorial on it for The Lancet.
Fortuitously, at that conference, I was sitting in the audience next to Andy Leather who got up and gave a short talk reacting to the global need for surgery that prompted me to discuss with him the need to pull together all of these people doing bits and pieces globally. I remember saying “there’s a lot of passion but a rather fragmented response. I wonder if what we should do around this is a Lancet Commission.”

I later explained to my colleagues at The Lancet that although there was not much evidence, there were lots of passionate people, and a Commission would really set global surgery on the world stage when it comes to global health.

Andy and I then started working very closely with John Meara and Lars Hagander, and we pulled together others to try and flesh out what we wanted to achieve with the Commission. Because I was so involved with the process I not only became an author on the Commission - shepherding it, together with co-leads Andy, Lars and John - but that’s actually what made me go back into research.

WFSA: Are you still working on research in the area of global surgery/anaesthesia following the publication of The Lancet Commission’s findings?

JD: Now I’m a part time Professor of Global Health at KCL, working with Andy Leather, doing various pieces of research on health systems and health systems strengthening for surgery, as well as cardiovascular disease. I got so involved with the Commission, and the primary research we did, that going back to being an editor and processing other people’s work, brilliant though it may be, was no longer so appealing.

I’m now leading the process of collecting data from countries worldwide based on the six metrics for assessing global surgery outlined by The Lancet Commission. Over the last two years we have tried to see if we can obtain the data behind those metrics; looking to see if they were collectable, meaningful, and actually comparable. We have just finished analysing the data and are now preparing the results for publication. [The number of countries in the study] vary depending on what metric you’re looking at and my talk at the SAFE-T Summit will give a little teaser of these results and issues around data collection.

WFSA: Where do you see global surgery and cardiovascular disease within the global health sphere? And how can data help improve related health outcomes?

JD: I think the world has woken up to NCDs being a major issue, especial cardiovascular disease, which is very encouraging to see. It’s also great that NCDs have made it into a prominent position in the Sustainable Development Goals (SDGs), and are of course essential to achieving Universal Health Coverage (UHC).

With respect to surgery, if one looks at obstetric complications and maternal health, as well as injuries, these are specifically mentioned in the SDGs. However, if you look at injuries, the inclination is to think more of prevention rather than strengthening systems to provide care for the injured patient. So, while I think it’s good that some surgical conditions are there, I think that their presence on the SDGs is not proportionate to the urgent need to improve health systems to deal with all surgical conditions.

When it comes to the rest of surgery, of course it’s crucial to UHC, so it should be prominent on the global health agenda. But unfortunately, it suffers from some major problems which perhaps limit this . One such problem is that surgery is a treatment modality, rather than a disease, so it is difficult to conceptualise in order to measure it within a health system. This is important as the ability to put numbers to a particular issue is a really useful advocacy tool. Another problem is that whilst studies have shown that surgery is effective and is rather cheap compared to other health modalities, it is viewed as being expensive by many people outside of the global surgery community – that also limits its appeal as an intervention to improve health.

WFSA: Speaking of metrics, how can data help improve health outcomes when it comes to surgical practice and surgical conditions?

JD: I think there are issues around metrics for surgery which need to be thought through for data to become a really powerful tool for improving access to safe affordable surgical care. As we’ve found in our recent global data collection, these metrics, firstly, are not collected everywhere so there is a lack of data. Secondly, it’s challenging to define and nail down what is actually needed in data collection related to surgery, and accountability is difficult to achieve unless you have the metrics to judge how countries and health services are progressing. To enable data to speak for surgery we need to have tangible and tractable metrics that are collected in a similar form from all nations.

The other thing with healthcare metrics is that there’s a lot of top-level reporting for use in global health accountability, feeding into things like the SDGs, or based on the reporting demands of various bilateral and multilateral organisations. All donors want to know that you are achieving aims around a particular goal, so there is quite a lot of reporting for each individual donor. But there is less thinking about what that data means for the care of the individual patient or for health system planning. This can lead to a disjunct between collecting data at the health service level for the purpose of patient care, and the collection and reporting of data which is useful for global health accountability. In an ideal situation, data which are necessary for patient care are also used for global health reporting at an international level. Unfortunately for surgery, in many countries, even data relevant to patient care are not rigorously collected. However, that does provide a fantastic opportunity for these countries to start collecting data for surgery well, from the start.

To learn more about the SAFE-T Summit and to register please click here.

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Dr Justine Davies’ Dip ABRSM BMSc, BSc, MBChB, MRCP, MD objective is to improve health at individual and global levels, an objective she currently pursues as a Professor in Global Health at KCL and as visiting faculty at Wits University in South Africa. Dr Davies’ main academic interest is in building systems for better health care, particularly in areas of diseases amenable to surgery or in cardiovascular diseases. She is interested in the clinical and socio-economic consequences of treatment or failing to treat these conditions in Lower and Middle Income countries, especially sub-Saharan Africa, and is also interested in improving data collection for health system planning and ensuring access to surgical care for people living in LMICs.

Dr Davies has been an author on The Lancet Commission on Global Surgery, The Lancet Commission on Women and Health, and led the recently published The Lancet Diabetes & Endocrinology Commission on Diabetes in sub-Saharan Africa. Dr Davies have lectured around the world on the topics of global surgery, diabetes in resource constrained environments, health care data, good research practice and translating research into practice.

As well as working as an editor of The Lancet Diabetes & Endocrinology, a clinician, and researcher, she has been a freelance journalist and worked as a scientific advisor to the BBC. In her spare time, Dr Davies tries (unsuccessfully) not to fall off horses and plays the violin in a chamber music setting.